Pregnancy, Child Birth and Breast Feeding

Dr.K.Kolanda Swamy.
MBBS, MAE, DPH, DIH, DBE,
PG in Global Health (Japan),
PG in HFW Management.

31st July, 2020 Public Health Expert in Infectious Diseases Control,

Immunisation, MCH and Disaster Management.
 Why Special Care for
Pregnancy and Child Birth?
Ante Natal Care
 Special Care in a health facility for
Pregnant and mothers with infants

• Women, postnatal mothers and infants need

to be protected from being infected when

they come to a health facility

• Separate place and timing to be followed in

all health facility for vulnerable population

Separate block/building or timing for Pregnant Mothers

• Hospital process should be re-organised in such

a way, that there is no contact/common
service points

• Appropriate barricades must be in place

• Signages should be put up to indicate the

restricted areas
 High Risk Mothers
• For any kind of Influenza Like Illness (ILI), pregnant and lactating
mothers and children are vulnerable
• Risk of getting severe form of COVID-19 is high for mothers with
• Gestational Diabetes Mellitus (GDM)
• Pregnancy Induced Hypertension (PIH)
• Heart diseases
• Severe hypothyroidism and
• Other comorbid conditions
RT-PCR test for Corona virus, five days before EDD or
immediately on admission

• Two-thirds of deliveries occur in government hospitals:

Unless Corona positive mothers are admitted in separate
rooms, High Risk Pregnant mothers will be at risk.
• Testing will enhance the Confidence of doctors and
nurses
• Since pregnant women, do not venture out much,
testing all pregnant women will be an excellent default
sample for detecting the entry of infection in an area.
Care of Pregnant Women
▪ Pregnant mothers with pre-existing co-morbid
conditions and pregnancy related high risk conditions
▪ Antenatal visits should be regular
▪ 30 days medicine should be available at home
▪ Mothers should be aware of danger signs
▪ Mobile numbers of area Village Health Nurse VHN/
Urban Health Nurse (UHN) and PHC MOs should be
available readily
Delivery Care for Suspected or
confirmed COVID-19 mother
Delivery Care for Suspected or confirmed COVID-19 mother

• Separate well ventilated room to be converted as birth room

• All essential facilities for child-birth should be made available

• Prescribed standard protocols should be followed in the birth room

• Adequate number of exhaust fans should be fixed in bathroom

toilets and other suitable places for improving ventilation

Ancestral • Exclusive Hospitals for Women and
Wisdom
Children across the world
• Exclusive Hospitals/blocks for
Infectious diseases
• Maternity Centres for Women and
Children for essential MCH care
• Dispensaries for infectious diseases
and other disease conditions
 Modern Wisdom
• All under one roof which include maternity, child health, all
infectious diseases including TB under the modern management
terminology called ‘Constellation of Services’ (meaning all under
one roof)

• All maternity centres are either converted into Rural or Urban

PHC.

• Hospitals have clearly emerged as amplifiers of infectious diseases

particularly Influenza Like Illnesses and dengue.
 COVID-19
Breast Feeding Recommendations
 Benefits of Breast feeding
B • Best for the Baby and Mother
• Bonding between mother and baby is promoted
R • Readily available
E • Enteric infections are reduced

A • Antimicrobial factors such as macrophages, lymphocytes, secretary IgA,

anti streptococcal factor, lysozyme and lactoferrin prevents diarrhoeal
diseases and respiratory infections

S • Sufficient, Stools inoffensive, Safe, Survival chances are greater

T • Temperature optimal for the infant

 Benefits of Breast feeding
F • Family Planning (Lactation amenorrhoea)

E • Enhances Visual Acquity

E • Economical

D • Digested easily by normal babies and premature babies

I • IQ is higher among breastfed babies: Ideal food for the infants

N • Nutritional requirements are fulfilled

G • Growth and development of jaws and teeth

Benefits for the mother

• Reduces the risk of PPH and anaemia

• Immunity of the mother improves

• Delays next pregnancy

• Protects mothers from ovarian and

breast cancers and osteoporosis
Breast Feeding Recommendations of WHO
• Recommendations of World Health Organisation (WHO) on
mother/infant contact and breastfeeding are based on
• a full consideration not only of the risks of infection of the
infant with COVID-19
• but also the risks of serious morbidity and mortality associated
with not breastfeeding or the inappropriate use of infant
formula milks
• as well as the protective effects of skin-to-skin contact and
breastfeeding.
 Facts about COVID-19 and Breastfeeding

• High quality evidence shows that breastfeeding

• reduces neonatal, infant and child mortality including in high
resource settings and
• improves lifelong health and development in all geographies and
economic settings.

• The transmission of COVID-19 through breastmilk and

breastfeeding has not been detected.
 Facts about COVID-19 and Breastfeeding

• Among the few cases of confirmed COVID-19 infection in children

from other sources, most have experienced only mild or
asymptomatic illness.

• While breastfeeding, a mother should still implement appropriate

hygiene measures, including wearing a medical mask if available, to
reduce the possibility of droplets with COVID-19 being spread to her
infant.
 Transmission of COVID-19 through Breast Feeding

• Transmission of active COVID-19 (virus that can cause infection)

through breast milk and breastfeeding has not been detected to
date.

• It appears unlikely, that COVID-19 would be transmitted through

breastfeeding or by giving breastmilk that has been expressed by a
mother who is confirmed/suspected to have COVID-19.

• There is no reason to avoid or stop breastfeeding.

 Breastfeeding in COVID-19 prevalent areas

• In all socio-economic settings, breastfeeding improves survival and

provides lifelong health and development advantages to newborns
and infants.

• Breastfeeding also improves the health of mothers.

• In contrast, transmission of COVID-19 through breastmilk and

breastfeeding has not been detected.

• There is no reason to avoid or stop breastfeeding.

Skin-to-skin care and breastfeed if the mother is confirmed or
suspected to be COVID-19 positive

• Immediate and continued skin-to-skin care, including

kangaroo mother care,
• improves the temperature control of newborns
• improves survival among newborn babies
• Better physiological outcomes
Skin-to-skin care and breastfeed if the mother is confirmed or
suspected to be COVID-19 positive

• Placing the newborn close to the mother also enables

early initiation of breastfeeding which also reduces
mortality.

• The numerous benefits of skin-to-skin contact and

breastfeeding substantially outweigh the potential risks of
transmission and illness associated with COVID-19.
 Precautions
• Hand Hygiene
• Wash hands frequently with soap and water especially
before touching the baby
• Respiratory Hygiene
• Wear a medical mask during any contact with the baby,
including while feeding
• Sneeze or cough into a tissue and then dispose of it
immediately and wash hands again
• Surface Hygiene
• Routinely clean and disinfect surfaces that mothers have
touched.
 Medical Masks
• It is important to replace medical masks as
soon as they become damp and dispose of
them immediately.

• Minimum three to four masks per day are to

be used

• Masks should not be reused

• Masks should not be touched in the front.

 If Medical Masks are not available…..

• Good quality cloth masks can be used

• Three or four masks may be used daily
• After use, mask and other clothes should be soaked in hot
water with detergent for half an hour and dried under
sunlight
• If dried under shade, it can be pressed with an
electric calender, popularly known as Iron Box.
Is it necessary for a mother with confirmed/ suspected COVID-19
to wash her breast before she breastfeeds directly or before
expressing milk?

• If a mother is confirmed/suspected to have COVID-19 has just

coughed over her exposed breast or chest, then she should gently
wash the breast with soap and warm water for at least 20 seconds
prior to feeding.

• It is not necessary to wash the breast before every breastfeed or

prior to expressing milk.
Alternate Ways when the mother is very sick and
unable to breastfeed
• Expressed breastmilk
• The expressed breastmilk should be fed to the child preferably using a clean cup
and/or spoon (easier to clean), by a person who has no signs or symptoms of
illness and with whom the baby feels comfortable.
• The mother/caregiver should wash their hands before feeding the
newborn/infant.

• Donor human milk

• If the mother is unable to express milk and milk is available from a human milk
bank, donor human milk can be fed to the baby while the mother is recovering.

• Wet-nursing (another woman breastfeeds the child)

 Expressed Breast Milk
• It is safe to give expressed breastmilk from a
mother confirmed/suspected to have COVID-19

• Active COVID-19 virus has not, to date, been

detected in the breastmilk of any mother
confirmed/ suspected to have COVID-19.

• It is unlikely that the virus can be transmitted by giving breastmilk

that has been expressed by a mother with confirmed/suspected
COVID-19.
Hygiene Measures for giving Expressed Breast Milk

• Even when COVID-19 is not a consideration, breastmilk pumps,

milk storage containers and feeding utensils need to be
appropriately cleaned after every use

• Wash the pump/containers after every use with liquid soap or dish
washing liquid and warm water.

• Rinse after with hot water for 10-15 seconds

 Wet Nursing
• Wet-nursing (another woman breastfeeds the child) may be an
option depending on acceptability to mothers/ families, cultural
acceptability, availability of wet-nurses and services to support
mothers/wet-nurses
• In settings where HIV is prevalent, prospective
wet-nurses should undergo HIV counselling
and testing if not done during her antenatal
period
 Restarting Breastfeeding after the illness

• A mother can start to breastfeed when she feels well enough to do so.
• There is no fixed time interval to wait after confirmed/suspected
COVID-19.
• There is no evidence that breastfeeding changes the clinical course of
COVID-19 in a mother.
• She should be supported in her general health and nutrition to ensure
full recovery.
• She should also be supported to initiate breastfeeding or re-lactate.
Results of COVID-19 testing and infant and young child
feeding recommendations

• COVID-19 testing does not have any immediate implications for

decisions on infant and young child feeding.

• However, confirmation of COVID-19 means that a mother should

implement appropriate recommended hygiene practices for the
period that she is likely to be infective (while symptomatic or
through the 14 days after the start of symptoms, whichever is
longer).
 Support to the feeding mother

• Mothers who breastfeed should be counselled and

supported to optimise positioning and attachment
to ensure adequate milk production.

• Mothers should be counselled about responsive

feeding and perceived milk insufficiency and how to
respond to their infants’ hunger and feeding cues to
increase the frequency of breastfeeding.
 Key Messages
• Breastfeeding and skin-to-skin contact significantly reduce
the risk of death in newborns and young infants and provide
immediate and lifelong health and development advantages.

• Breastfeeding also reduces the risk of breast and ovarian

cancer for the mother.

• Newborns and infants are at low risk of COVID-19 infection.

 Key Messages
• Among the few cases of confirmed COVID-19 infection in young
children, most have experienced only mild or asymptomatic illness

• The numerous benefits of breastfeeding substantially outweigh the

potential risks of transmission and illness associated with COVID-19.

• Active COVID-19 has not been detected in the breastmilk of any

mother with confirmed/suspected COVID-19 and there is no evidence
so far that the virus is transmitted through breastfeeding.
 Infant Formula Milk

• There are always risks associated with giving infant

formula milk to newborns and infants in all settings

• Infant Formula Milk will reduce the amount of milk

produced by a mother.
 Donations of infant formula milks

• Donations of infant formula milks should not be sought or

accepted.

• Donations to Government Health Care facilities by Infant Formula

Milk Companies are prohibited

• Entry into a Govt Health Facility, distribution of pamphlets and

samples and other promotional activities are prohibited
Cows’ milk for calves:

Human Milk for Babies

Thank you